Access to high-volume TAVR operators varies widely across US
Transcatheter aortic valve replacement among Medicare beneficiaries grew rapidly from 2014 to 2018 with an expansion in TAVR operators, but more than one-third of operators are performing fewer than 10 procedures per year, data show.
TAVR is the standard of care for most patients with severe symptomatic aortic stenosis; yet despite an association between operator procedural volume and outcomes, nationwide TAVR operator volumes have been incompletely described, Timothy Simpson, MD, PharmD, fellow in cardiovascular medicine at Oregon Health & Science University, and colleagues wrote in Catheterization and Cardiovascular Interventions.
“We know that operator volumes are an important variable for outcomes in many cardiac procedures,” Simpson told Healio. “Several studies demonstrate a volume-outcome association where high-volume operators are associated with improved TAVR outcomes. Our study sheds light on the case volumes of a typical TAVR operator in the U.S., as well as the trends in growth of TAVR procedures and corresponding growth in the number of TAVR operators.”
Simpson and colleagues analyzed Medicare Provider Utilization and Payment Data for transfemoral TAVRs from 2014 to 2018, assessing annual operator volume, state and regional volumes and longitudinal trends.
In 2018, the mean annual operator volume was 23.6 TAVRs and the highest 1% of operators by volume performed 7.6% of total TAVR procedures in the U.S., whereas 35.7% of operators performed 10 or fewer TAVRs per year.
From 2014 to 2018, there was a 53.9% annualized increase in TAVRs, and the mean annual volume per operator grew from 12.5 to 23.6.
In 2018, there was more than fivefold variability in the density of operators, ranging from 0.35 to 1.79 operators per 100,000 population. The mean operator volume by state also varied widely, from 14.2 to 52.4 TAVRs per operator. There were no TAVR operators in Wyoming in 2018.
“With most TAVR operators performing a median of fewer than 25 TAVRs per year, our study sheds light on an important policy conundrum: to balance equitable access to TAVR therapy for patients from all demographics while confirming we are providing high-quality outcomes to our patients, Simpson told Healio. “In addition, we need better studies to help understand how TAVR volumes per operator vs. TAVR volumes per center affect outcomes.”
Simpson said researchers must continue to monitor operator volumes, as data suggested a plateau of operator volumes.
“We also need to better understand how continued improvement in techniques and equipment and a growing lifetime experience of performing TAVR will affect volume-outcomes association,” Simpson said. “Lastly, as operator volumes are only one surrogate for competency and one of likely many variables associated with improved outcomes, we need to better understand how we can confirm we are delivering quality care and superior outcomes to our patients.”
For more information:
Timothy F. Simpson, MD, PharmD, can be reached at simpsont@ohsu.edu.
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